Neurodevelopmental Outcomes of Extremely Premature Infants with Extremely Low and Very Low Birth Weight at Three Years of Age: A Retrospective Study

Introduction: The purpose of this retrospective study is to identify medical conditions impacting neurodevelopmental outcomes of extremely low birth weight and very low birth weight preterm infants at three years of age. Methods: Infants born in Banner Diamond Children’s University Medical Center, receiving services in the Newborn Intensive Care Unit, and attending Neonatal Developmental Follow-Up Clinic were identified. Participants received developmental assessment and follow-up from August 2012 through December 2018. Relevant clinical conditions during initial hospital stay and up to three years of age were obtained by reviewing medical and developmental records. Bayley Scales of Infant Toddler Development (Bayley III) was used to evaluate skill development at 6, 9, 12, 18, 24, 30, 36 months. Results: Data analysis did not reveal significant p-values;it did demonstrate that some predictor variables impact neurodevelopmental outcomes in cognitive, language and motor skill development. Conclusion: This retrospective study reports significant association between birth weight and low cognitive scores. Correlations were also found between gestational age and Total Language, and the longer an infant stayed in the NICU, the poorer the Total Language Scaled Scores at 8 to 12 months, 15 to 18 months, and 24 to 36 months. Birth weight was found to be the greatest predictor of poor motor scores.

Mortality and Morbidity of Extremely Low Birth Weight Infants in the Mainland of China： A Multi-center Study

Background： With the progress ofperinatal medicine and neonatal technology, more and more extremely low birth weight （ELBW） survived all over the world. This study was designed to investigate the short-term ontcomes of ELBW infants during their Neonatal Intensive Care Unit （NICU） stay in the mainland of China. Methods： All infants admitted to 26 NICUs with a birth weight （BW） 〈1000 g were included between January 1,2011 and December 31,2011. All the data were collected retrospectively from clinical records by a prospectively designed questionnaire. The data collected from each NICU transmitted to the main institution where the results were aggregated and analyzed. Categorical variables were performed with Pearson Chi-square test. Binary Logistic regression analysis was used to detect risk factors. Results： A total of 258 ELBW infants were admitted to 26 NICUs, of whom the mean gestational age （GA） was 28.1 ± 2.2 weeks, and the mean BW was 868 ± 97 g. The overall survival rate at discharge was 50.0%. Despite aggressive treatment 60 infants （23.3%） died and another 69 infants （26.7%） died after medical care withdrawal. Furthermore, the survival rate was significantly higher in coastal areas than inland areas （53.6% vs. 35.3%, P = 0.019）. BW 〈750 g and GA 〈28 weeks were the largest risk factors, and being small for gestational age was a protective factor related to mortality. Respiratory distress syndrome was the most common complication. The incidence of patent ductus arteriosus, intraventricular hemorrhage, periventricular leukomalacia, bronchopulmonary dysplasia, retinopathy of prematurity was 26.2%, 33.7%, 6.7%, 48.1%, and 41.4%, respectively. Ventilator associated pneumonia was the most common hospital acquired infection during hospitalization. Conclusions： Our study was the first survey that revealed the present status of ELBW infants in the mainland of China. The mortality and morbidity of ELBW infants remained high as compared to other developed countries.

Delivery room resuscitation and short-term outcomes of extremely preterm and extremely low birth weight infants: a multicenter survey in North China

Background:Delivery room resuscitation assists preterm infants,especially extremely preterm infants(EPI)and extremely low birth weight infants(ELBWI),in breathing support,while it potentially exerts a negative impact on the lungs and outcomes of preterm infants.This study aimed to assess delivery room resuscitation and discharge outcomes of EPI and ELBWI in China.Methods:The clinical data of EPI(gestational age[GA]<28 weeks)and ELBWI(birth weight[BW]<1000 g),admitted within 72 h of birth in 33 neonatal intensive care units from five provinces and cities in North China between 2017 and 2018,were analyzed.The primary outcomes were delivery room resuscitation and risk factors for delivery room intubation(DRI).The secondary outcomes were survival rates,incidence of bronchopulmonary dysplasia(BPD),and risk factors for BPD.Results:A cohort of 952 preterm infants were enrolled.The incidence of DRI,chest compressions,and administration of epinephrine was 55.9%(532/952),12.5%(119/952),and 7.0%(67/952),respectively.Multivariate analysis revealed that the risk factors for DRI were GA<28 weeks(odds ratio[OR],3.147;95%confidence interval[CI],2.082–4.755),BW<1000 g(OR,2.240;95%CI,1.606–3.125),and antepartum infection(OR,1.429;95%CI,1.044–1.956).The survival rate was 65.9%(627/952)and was dependent on GA.The rate of BPD was 29.3%(181/627).Multivariate analysis showed that the risk factors for BPD were male(OR,1.603;95% CI,1.061–2.424),DRI(OR,2.094;95% CI,1.328–3.303),respiratory distress syndrome exposed to≥2 doses of pulmonary surfactants(PS;OR,2.700;95%CI,1.679–4.343),and mechanical ventilation≥7 days(OR,4.358;95% CI,2.777–6.837).However,a larger BW(OR,0.998;95% CI,0.996–0.999),antenatal steroid(OR,0.577;95%CI,0.379–0.880),and PS use in the delivery room(OR,0.273;95%CI,0.160–0.467)were preventive factors for BPD(all P<0.05).Conclusion:Improving delivery room resuscitation and management of respiratory complications are imperative during early management of the health of EPI and ELBWI.

Respiratory management of extremely low birth weight infants: survey of neonatal specialists

Background:To investigate strategies used for the management of respiratory distress syndrome(RDS)and bronchopulmonary dysplasia(BPD)in extremely low birth weight(ELBW)infants.Methods:A survey of neonatal specialists working in US academic institutions with fellowship training programs.Results:Eighty percent(72/89)of the identifi ed academic institutions had at least one physician who responded to the survey.Among respondents,85%(171/201)agreed or strongly agreed to use continuous positive airway pressure(CPAP)initially for the management of RDS,and the majority agreed or strongly agreed to use a fraction of inspired oxygen(FiO2)≥0.4 and a mean airway pressure(MAP)≥10 cm H2O as a criteria for surfactant therapy;and 73%(146/200)sometimes or always used caffeine to prevent BPD.Only 25%(50/202)sometimes or almost always used steroids to prevent or treat BPD.Identified indications to use steroids were 3 or more extubation failures or inability to extubate beyond 8 weeks of age.Conclusions:Variability in treatment strategies of ELBW is common among neonatal specialists.However,the majority of the respondents agreed or strongly agreed to use early CPAP for the management of RDS,consider a FiO2≥0.4 and a MAP≥10 cm H2O as criteria for surfactant therapy,and sometimes or almost always used caffeine to prevent BPD.Steroids continue to have a role in the management of BPD in infants who are diffi cult to extubate.

Fish oil-containing lipid emulsions prevention on parenteral nutrition-associated cholestasis in very low birth weight infants:a meta-analysis

Background The effect of fish oil-containing lipid emulsions on preventing parenteral nutrition-associated cholestasis(PNAC)in very low birth weight(VLBW)infants is not known.Thus,we conducted a meta-analysis to identify any preven-tion effect.Methods PubMed,EMBASE,and CENTRAL were searched up to 26 January 2021 for studies related to the preventive effect of fish oil-containing lipid emulsions and fish oil-free lipid emulsions on cholestasis in VLBW infants.Revman 5.3 was used to synthesize the results.A fixed-effect model was used to summarize the data when the heterogeneity was non-significant(I2<50%),and a random-effects model was used when the heterogeneity was significant(I2>50%).Results Of 728 articles,11 randomized controlled trials met the inclusion criteria.The meta-analysis indicated that fish oil-containing lipid emulsion reduced the occurrence of PNAC significantly with risk ratio(RR)=0.53,95%confidence interval(CI)0.36-0.80,P=0.002.The heterogeneity was non-significant with I2=23%.Subgroup analysis based on par-enteral nutrition duration and median birth weight was performed.The synthesis results for patients with parenteral nutri-tion duration exceeding 14 days revealed I2=35%(P=0.15)and pooled RR=0.47,95%CI 0.30-0.73,P=0.0008;and for patients with duration less than 14 days revealed I2=0%(P=0.72)and pooled RR=1.14,95%CI 0.39-3.35,P=0.81.The synthesis for patients with birth weight more than 1000 g revealed I2=0%(P=0.41)and pooled RR=0.55,95%CI 0.26-1.18,P=0.12;and for patients with birth weight below 1000 g revealed I2=44%(P=0.11)and pooled RR=0.53,95%CI 0.33-0.85,P=0.009.Conclusions The fish oil-containing lipid emulsion can reduce the occurrence of PNAC in VLBW infants based on the avail-able original randomized controlled trial studies,especially for patients with parenteral nutrition duration exceeding 14 days and extremely low birth weight infants.Future studies should be performed before a definitive conclusion can be established.

超早产儿获得性巨细胞病毒感染的临床检测及分析

目的探讨获得性巨细胞病毒感染在超早产儿中的临床应用价值。方法回顾性分析本院新生儿科2023年7月1日至9月15日送检的1072例新生儿血清样本的巨细胞病毒相关抗体检测结果。结果1072例样本中有2例患儿确诊获得性巨细胞病毒感染。该2例患儿均为超早产儿(胎龄24~27+6周)、超低出生体重儿(750~999 g),均以血小板降低为首发表现,1例为输血获得性巨细胞病毒感染,另1例为母乳获得性巨细胞病毒感染。结论在超早产儿这类特殊人群中,输血治疗时需警惕输血获得性巨细胞病毒感染,同时也要谨防母乳获得性巨细胞病毒感染,必要时经巴氏消毒后再喂养。

1例超低出生体重儿经外周静脉置入中心静脉导管置管后并发心包填塞的护理

本文总结1例经外周静脉置入中心静脉导管(PICC)引起心包填塞的护理,以提高临床对本病的认识及预防。通过观察患儿局部与全身情况,采用胸部X线和心脏彩超进行检查,确诊患儿发生心包填塞及PICC异位,通过紧急行心包穿刺术,缓解心包填塞症状;及时拔除中心静脉置管,给予呼吸、循环、营养、重新置管等方面的支持治疗,并积极做好早产儿术后精细化护理。通过实施上述措施后,该患儿术后第7天心包腔无液性暗区、心影缩小,心率恢复正常,并在治疗68d后康复出院。积极预防深静脉导管并发症,在置管前应充分评估患儿,做好置管前准备。同时,置管及维护人员应具备丰富的临床经验,根据个体选择合适的置管方式、护理方案,才能降低不良事件发生率,保障置管的安全性。

一例超低出生体重儿脐动脉置管后并发肢体缺血性坏死的护理

总结2022年11月我院收治的1例超低出生体重儿(ELBWI)脐动脉置管后并发肢体缺血性坏死的护理经验。护理要点:组建多学科团队,制定精细化护理方案,肢体缺血性坏死的及时识别,予以个体化护理包括做好血管活性药物用药护理,避免药物不良反应,保证湿度与温度,维持有效外环境以及局部氧疗。经过精心的治疗及护理,患儿顺利出院,且未发现肢体生长异常等远期并发症。

超/极低出生体重儿嗜酸性粒细胞增多症与支气管肺发育不良的临床相关性分析

目的探讨发生不同程度嗜酸性粒细胞增多症的超低出生体重儿(extremely low birth weight infants,ELBW)和极低出生体重儿(very low birth weight infants,VLBW)的临床特点,以及嗜酸性粒细胞增多症与支气管肺发育不良(bronchopulmonary dysplasia,BPD)的相关性。方法回顾性分析2019年1月至2022年12月解放军总医院第五医学中心儿科收治的147例ELBW及VLBW患儿的临床资料。根据嗜酸性粒细胞计数升高程度进行分组:正常组(嗜酸性粒细胞计数<0.7×10^(9)/L,n=43),轻度升高组[嗜酸性粒细胞计数为(0.7~0.9)×10^(9)/L,n=39]、中重度升高组(嗜酸性粒细胞计数≥1.0×10^(9)/L,n=65),比较各组围产期资料以及出生后相关疾病的发生率。根据患儿是否患有BPD以及BPD的严重程度分为无BPD组(n=81),轻度BPD组(n=46),中重度BPD组(n=20),比较3组患儿之间嗜酸性粒细胞计数的差异。统计学方法包括t检验、方差分析、秩和检验、χ^(2)检验、Fisher确切概率法,以及单因素和多因素Logistic回归分析、受试者工作特征(receiver operating characteristic,ROC)曲线。结果嗜酸性粒细胞增多症的发病率为70.7%(104/147),其中轻度升高26.5%(39/147),中重度升高44.2%(65/147)。中重度升高组和轻度升高组胎龄均小于正常组,差异均有统计学意义(P值均<0.05)。嗜酸性粒细胞计数轻度、中重度升高组中败血症、Ⅱ度以上呼吸窘迫综合征(respiratory distress syndrome,RDS)、BPD、血液输注的发生率明显高于正常组;中重度升高组患儿的BPD发生率高于轻度升高组;轻度、中重度升高组无创呼吸机应用时间均长于正常组,差异均有统计学意义(P值均<0.05)。无BPD组和BPD组患儿的胎龄、败血症的发生率以及嗜酸性粒细胞增多症、呼吸机应用天数、血液输注比较,差异均有统计学意义(P值均<0.05)。多因素Logistic回归分析结果显示,胎龄、嗜酸性粒细胞增多症、呼吸机应用天数、血液输注、败血症与BPD的发生具有独立相关性(P值均<0.05)。出生后第3周嗜酸性粒细胞计数的曲线下面积(area under the curve,AUC)最大(0.772),灵敏度及特异度均较高(70.1%、76.2%),提示对BPD的预测价值较好。出生后第3、4周轻度BPD组患儿嗜酸性粒细胞计数高于无BPD组(Z=-3.178、-2.475,P=0.001、0.013)。出生后第3、4周中重度BPD组患儿嗜酸性粒细胞计数高于无BPD组(Z=-2.601、-2.460,P=0.009、0.014)。出生后第3周中重度BPD组患儿嗜酸性粒细胞计数高于轻度BPD组(Z=-2.422,P=0.015)。结论ELBW及VLBW新生儿嗜酸性粒细胞增多症发生率较高,并且嗜酸性粒细胞增多症与BPD的发生存在一定的相关性。出生后第3周嗜酸性粒细胞计数预测BPD的灵敏度及特异度最高,临床上应加以重视。

极/超低出生体重儿出生后1周内并发高血糖的影响因素分析

目的:分析极/超低出生体重儿出生后1周内并发高血糖的影响因素。方法:回顾2016年8月—2023年8月在上饶市人民医院新生儿科出生的300例极/超低出生体重儿资料,根据出生后1周内是否并发高血糖(空腹血糖>7 mmol/L)分为正常组(n=220)和异常组(n=80),比较两组资料。结果:出生后1周内高血糖发生率26.67%(80/300),发生时间多在24 h内,平均高血糖持续时间(3.44±0.52)d,首发高血糖浓度平均(9.34±1.03)mmol/L;异常组体重<1500 g、5 min新生儿Apgar评分≤7分、胎龄<28周比例均高于正常组,差异均有统计学意义(P<0.05);异常组新生儿母亲年龄≥35岁、妊娠期糖尿病、妊娠期高血压疾病比例均高于正常组,差异均有统计学意义(P<0.05);异常组新生儿葡萄糖输注速度4~6 mg/(kg·min)、禁食时长≤1 d比例均低于正常组,机械通气、新生儿窒息比例均高于正常组,差异均有统计学意义(P<0.05);体重、胎龄、5 min新生儿Apgar评分、葡萄糖输注速度、新生儿窒息是极/超低出生体重儿出生后1周内并发高血糖的影响因素(P<0.05)。结论:极/超低出生体重儿出生后1周内高血糖发生率较高,体重、胎龄、5 min新生儿Apgar评分、葡萄糖输注速度、新生儿窒息是其影响因素,临床应针对上述指标针对性预防。

两种不同延续服务在极低出生体重儿的应用研究

目的本研究旨在探讨两种不同出院后延续服务对极低出生体重儿的影响。方法纳入2022年3月—2023年3月我院新生儿科收治并达到出院标准的66例极低出生体重儿,随机分为观察组与对照组,两组均按常规高危儿门诊随访进行评估。观察组实施微信平台进行出院后延续服务,对照组实施电话回访管理。观察两组患儿随访完成率、再次入院率、家属焦虑情况及护理工作满意度。结果进行延续护理服务6个月后,观察组随访完成率、家属对护理的满意度均高于对照组(均P<0.05);观察组再次住院率、家属焦虑率均低于对照组(均P<0.05)。结论基于微信平台的极低出生体重儿出院后延续服务应用可行,可以提高极低出生体重儿随访率、降低再入院率、减轻家属焦虑情绪,同时提高家属对护理工作满意度。

初乳滴注联合专科针对性护理对缩短极低出生体重儿全肠道喂养时间效果分析

目的探讨初乳滴注联合专科针对性护理对缩短极低出生体重儿全肠道喂养时间效果。方法选取2020年1月至2022年12月我院的60例极低出生体重儿,按数字随机分组法将其分入试验组和对照组,每组30例。对照组患儿采用初乳滴注联合常规护理,试验组患儿实施初乳滴注联合专科针对性护理。对两组患儿全肠道喂养时间、全经口喂养时间、恢复正常出生体重时间和两组患儿胃潴留情况(胃潴留次数、潴留量)进行对比分析。结果试验组患儿全肠道喂养时间、全经口喂养时间、恢复正常出生体重时间均短于对照组(P<0.05);试验组患儿胃潴留次数、潴留量均低于对照组(P<0.05)。结论初乳滴注联合专科针对性护理能有效缩短极低出生体重儿全肠道喂养时间以及康复时间,加速改善胃潴留。

新生儿序贯器官衰竭评估评分对极低/超低出生体重儿晚发型败血症死亡风险预测价值

目的 探索新生儿序贯器官衰竭评估(nSOFA)评分对极低/超低出生体重儿晚发型败血症死亡风险的预测价值。方法 回顾性分析2017年1月至2021年12月收治的诊断为晚发型败血症的极低/超低出生体重儿的临床资料。在败血症确诊前后的5个时间点(T-24、T-12、T0、T12、T24)计算nSOFA评分,利用受试者工作特征(ROC)曲线分析nSOFA评分对患儿死亡风险的预测价值。结果 纳入患儿135例,男66例、女69例,败血症诊断年龄为21.0(13.5~25.0)d。113例患儿存活,死亡22例(病死率16.3%)。存活组与死亡组之间在T-12、T0、T12、T24时间点nSOFA评分差异均有统计学意义(P<0.05)。ROC曲线分析显示,T-12、T 0、T 12、T 24时间点nSOFA评分预测极低/超低出生体重儿晚发型败血症死亡风险的灵敏度分别为59.1%、81.8%、93.2%、98.3%,特异度分别为63.6%、71.7%、73.7%、89.9%,曲线下面积分别为0.64、0.79、0.89、0.95。T 24时nSOFA评分的灵敏度、特异度、曲线下面积均最大。结论 nSOFA评分对极低/超低出生体重儿晚发型败血症死亡风险具有预测价值,nSOFA评分越高,败血症患儿死亡风险越大。

极/超低出生体重早产儿早发型坏死性小肠结肠炎临床特征和危险因素分析

目的探讨极/超低出生体重早产儿早发型坏死性小肠结肠炎(necrotizing enterocolitis,NEC)的临床特征及危险因素。方法回顾性分析2014年1月—2021年12月郑州大学附属儿童医院收治的194例极/超低出生体重早产儿NEC病例的临床资料。按照NEC发病时间不同分为早发型(<14日龄发病,n=62)及晚发型两组(≥14日龄发病,n=132),比较两组围生期情况、临床特征、实验室检查结果、临床结局等。选择与这些NEC早产儿同期住院的,且胎龄和出生体重与之相近的非NEC患儿62例为对照组。采用多因素logistic回归分析探讨早发型NEC发生的危险因素。结果早发型组1 min Apgar评分≤3分、Ⅲ期NEC、手术干预治疗和脑室内出血≥3级的患儿比例高于晚发型组(P<0.05)。早发型组呼吸暂停、发热或体温不升的患儿比例高于晚发型组(P<0.05)。多因素logistic回归分析显示,喂养不耐受、血培养阳性的早发型败血症、重度贫血和有血流动力学意义的动脉导管未闭是极/超低出生体重早产儿早发型NEC发生的独立危险因素(P<0.05)。结论极/超低出生体重早产儿早发型NEC病情较晚发型NEC更严重;患有喂养不耐受、血培养阳性的早发型败血症、重度贫血或有血流动力学意义的动脉导管未闭患儿发生早发型NEC的风险较高。

六西格玛精益管理对极/超低出生体重儿生长代谢及并发症的影响

目的探讨六西格玛(6σ)精益管理对极/超低出生体重儿生长代谢及并发症的影响。方法选取2019年10月至2021年9月江苏省南通市妇幼保健院新生儿科收治的84例极/超低出生体重儿为研究对象,采用随机数字表法将其分为对照组和观察组,各42例。对照组行常规护理,观察组在此基础上行6σ精益管理。观察两组患儿出生时,住院7、14 d,出院14 d及出院30 d生长代谢和并发症发生率。结果整体分析发现,组间、时间点间及交互作用体重、经口热卡比较,差异均有统计学意义(P<0.05)。进一步两两比较,组内比较:两组患儿各时间点体重、经口热卡比较,差异均有统计学意义(P<0.05);组间比较:观察组患儿住院7、14 d,出院14 d及出院30 d时体重、经口热卡水平均高于对照组(P<0.05);两组患儿并发症总发生率比较,差异无统计学意义(P>0.05)。结论6σ精益管理可提高极/超低出生体重儿生长代谢水平,而对并发症发生风险的影响还待考证。

极低/超低出生体重儿生后1 min低Apgar评分的危险因素:多中心回顾性研究

目的探讨极低/超低出生体重儿生后1 min低Apgar评分(≤7分)的危险因素。方法回顾性收集2018年1月-2019年12月江苏省新生儿重症监护病房母乳喂养质量改进临床研究协作组多中心临床数据库极低/超低出生体重儿的临床资料。按生后1 min Apgar评分分为低Apgar评分组(Apgar评分≤7分)和正常Apgar评分组(Apgar评分>7分)。采用多因素logistic回归分析法探讨生后1 min低Apgar评分的影响因素。采用受试者操作特征曲线(receiver operating characteristic curve,ROC曲线)分析评价相关指标对生后1 min低Apgar评分的预测价值。结果纳入1809例极低/超低出生体重儿。1 min低Apgar评分发生率为52.90%(957/1809)。多因素logistic回归分析显示:胎龄越大,患儿出现1 min低Apgar评分的风险越小(OR=0.853,P<0.05);出生体重越大,患儿出现1 min低Apgar评分的风险越小(OR=0.999,P<0.05);羊水异常的患儿出现1 min低Apgar评分的风险较高(OR=1.646,P<0.05);产前使用糖皮质激素的患儿出现1 min低Apgar评分的风险较低(OR=0.502,P<0.05)。ROC曲线分析显示,胎龄、出生体重、羊水异常和产前使用糖皮质激素4个指标联合预测出现1 min低Apgar评分的灵敏度为0.554,特异度为0.680。结论低胎龄、低出生体重、羊水异常可增加极低/超低出生体重儿生后1 min低Apgar评分的风险,产前积极使用糖皮质激素有利于降低生后1 min低Apgar评分的风险。

影响超低出生体质量儿住院期间死亡风险评估的相关因素分析

【目的】探究影响不同新生儿危重评分对超低出生体质量儿(ELBWI)死亡风险准确预测的相关因素。【方法】自2019年1月1日至2021年1月1日南京医科大学附属儿童医院和东南大学附属中大医院溧水分院新生儿科收治的ELBWI 186例,经纳入和排除标准筛选后最终纳入125名ELBWI。其中死亡组47例、存活组78例。收集围生期一般资料以及新生儿急性生理学评分-Ⅱ(SNAP-Ⅱ)、新生儿急性生理学评分围生期补充-Ⅱ(SNAPPE-Ⅱ)、新生儿临床危险指数(CRIB)、新生儿临床危险指数-Ⅱ(CRIB-Ⅱ)以及国内开发的新生儿危重病例评分(NCIS)其包含的所有评分条目内容进行单变量、多变量统计,并绘制列线图及受试者工作曲线(ROC)进行分析。【结果】生后收缩压、最大吸入氧浓度、BE值和出生体质量是影响ELBWI死亡风险准确评估的重要因素[收缩压OR值0.968,95%CI:0.938-0.999,P=0.043;最大吸入氧浓度OR值1.020,95%CI:1.006-1.034,P=0.006;BE的OR值0.868,95%CI:0.786-0.959,P=0.005;出生体质量OR值0.994,95%CI:0.991-0.997,P=0.000],ROC示以上四者的综合曲线下面积0.71、95%可信区间0.610-0.799,优于CRIB评分。【结论】较低收缩压、较高吸入氧浓度、较大BE值、较小出生体质量为影响ELBWI死亡风险准确评估的关键因素。在新评分的开发中,推荐将以上四者纳入评估条目可得到效率更优的ELBWI危重评分预测体系。

极低体重儿振幅整合脑电图异常的影响因素

目的分析极低体重儿振幅整合脑电图(aEEG)异常的有关影响因素。方法选取2022年1月至2023年1月九江市妇幼保健院收治的80例出生周龄≤32^(+6)周的极低体重儿(体重≤1500 g)作为研究对象,出生后给予常规干预,于纠正胎龄32+周时完善aEEG检查,统计aEEG异常情况;另收集胎次等一般资料,以多因素logistic回归分析模型分析极低体重儿aEEG异常的影响因素。结果80例患儿中,共有39例发生aEEG异常,发生率为48.75%(39/80)。单因素分析显示,不同性别、胎次、生产方式、母流产史、母孕期糖尿病的极低体重儿的aEEG异常率比较,差异无统计学意义(P>0.05);不同出生体重、胎盘胎膜与脐带异常、绒毛膜羊膜炎、宫内窘迫、酸中毒的极低体重儿的aEEG异常率比较,差异有统计学意义(P<0.05)。多因素logistic回归分析显示,出生体重<1000 g(β=1.905,95%CI:2.461~18.330)、有胎盘胎膜与脐带异常(β=1.549,95%CI:1.784~12.414)、有绒毛膜羊膜炎(β=1.825,95%CI:2.338~16.443)、有宫内窘迫(β=1.347,95%CI:1.521~9.726)、有酸中毒(β=0.913,95%CI:1.012~6.132)为极低体重儿发生aEEG异常的危险因素(OR>1,P<0.05)。结论极低体重儿的aEEG异常发生率较高,而出生体重<1000 g、有胎盘胎膜与脐带异常、有绒毛膜羊膜炎等为患儿aEEG异常发生的危险因素,提示aEEG可于早期对患儿的神经系统发育情况进行评估。

出生体质量低于500 g超早产儿的生命与发育支持护理

总结3例出生体质量低于500 g、胎龄不足23周的超早产儿的生命与发育支持护理经验,为临床护理提供参考。3例超早产儿主要的救治方案包括断脐后气管插管、使用肺表面活性物质替代治疗、有创与无创呼吸支持治疗,根据病情给予抗感染治疗、动脉导管未闭治疗,根据循环状况使用血管活性药物,肠内和肠外营养支持,早产儿视网膜病的筛查与治疗等。结果3例分别住院112、125、125 d完全脱氧,喂养正常,康复出院。提出做好超早产儿生命支持护理和发育支持护理,可提高超早产儿存活率,减少并发症与后遗症的发生。

基于德尔菲法超/极低出生体重儿父母出院准备度调查问卷表的构建及评价

目的基于德尔菲法构建超/极低出生体重儿父母出院准备度调查问卷表,为新生儿科医护人员提供有效的超/极低出生体重儿父母出院准备度评估工具。方法通过查阅文献、经验总结及小组讨论等建立超/极低出生体重儿父母出院准备度调查问卷表初始指标条目,经德尔菲专家函询、样本测试对问卷进行条目筛选和信效度检验,形成正式问卷。结果最终形成超/极低出生体重儿身体状况、父母的自身状况、父母对超/极低出生体重儿疾病和照护知识、超/极低出生体重儿出院后父母应对能力、出院后期望获得社会支持5个维度共26个条目的问卷。问卷总体Cronbach’sα系数为0.807,各维度的Cronbach’sα系数分别为0.715~0.864;S-CVI为0.919,I-CVI为0.824~1.000,校正后的Kappa值为0.833~1.000;重测信度0.904;探索性因子分析提取5个公因子,问卷总体累积方差贡献率为62.11%。结论构建的超/极低出生体重儿父母出院准备度调查问卷表具有良好的信效度。